1、918 2023 年 8 月第 43 卷第 8 期 Jilin Journal of Chinese Medicine Aug.2023 Vol.43 No.8 DOI:10.13463/ki.jlzyy.2023.08.013PCI 术后心绞痛患者血府逐瘀汤治疗前后心功能和血脂水平变化研究霍 燕，魏晓鹏，史会娟，崔彩霞，王玉娟 （山西省长治市中医研究所附属医院心病科，山西 长治 046000）摘要：目的 探讨经皮冠状动脉介入治疗（PCI）术后心绞痛患者血府逐瘀汤治疗前后心功能和血脂水平变化。方法 采用随机数字表法将 120 例 2019 年 6 月 2022 年 6 月山西省长治市中医研究所
2、附属医院心病科门诊和住院收治的 PCI 术后心绞痛患者分为对照组（60 例）和观察组（60 例）。2 组均给予常规治疗，对照组在此基础上给予盐酸曲美他嗪片进行治疗，观察组在对照组基础上给予血府逐瘀汤进行治疗，2 组均治疗 3 个月。比较 2 组治疗3个月后的疗效，治疗前、治疗3个月后的心绞痛发生情况、西雅图心绞痛量表（SAQ）评分、中医证候积分、心功能及血脂。结果 治疗 3 个月后，观察组总有效率为 90.00%，高于对照组的 75.00%（P 0.05）。与治疗前比较，治疗 3 个月后，2 组每次心绞痛持续时间均缩短，且观察组短于对照组（P 0.05）；2 组每周心绞痛发生次数均减少，且观察
3、组少于对照组（P 0.05）；2 组 SAQ 评分及左室射血分数（LVEF）、每搏量（SV）均升高，且观察组高于对照组（P 0.05）；2 组左室收缩末期内径（LVESD）、胸闷、胸痛、心悸气短、面色紫黯、倦怠乏力评分、左室舒张末期内径（LVEDD）及血清 B 型钠尿肽（BNP）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）、总胆固醇（TC）水平均降低，且观察组低于对照组（P 0.05）。结论 PCI 术后心绞痛患者经血府逐瘀汤治疗后中医证候得到明显改善，血脂水平得以降低，心绞痛症状及心功能得到明显缓解，生活质量及疗效得以提高。关键词：心绞痛；经皮冠状动脉介入治疗；血府逐瘀汤；盐酸曲美他
4、嗪片；中医证候；心功能；血脂 中图分类号：R541.4 文献标志码：A 文章编号：1003-5699(2023)08-0918-04Changes of cardiac function and blood lipid in patients with angina pectoris after PCI before and after a treatment with Xuefu Zhuyu decoctionHUO Yan,WEI Xiaopeng,SHI Huijuan,CUI Caixia,WANG Yujuan(Department of Cardiology,Affiliated
5、Hospital of Changzhi Institute of Traditional Chinese Medicine,Changzhi 046000,China)Abstract:Objective To investigate the changes of cardiac function and blood lipid in patients with angina pectoris after percutaneous coronary intervention(PCI)before and after a treatment with Xuefu Zhuyu decoction
6、.Methods A total of 120 patients with angina pectoris after PCI admitted to the Cardiology Department of the Affiliated Hospital of Changzhi Institute of Traditional Chinese Medicine from June 2019 to June 2022 were selected as the research subjects,and they were divided into a control group(60 case
7、s)and an observation group(60 cases)by the random number table method.Both groups were given a routine treatment,and the control group was given trimetazidine hydrochloride tablets on that basis,while on the basis of the control group,the observation group was treated with 基金项目：山西省中医药管理局科研课题计划（2019Z
8、YYC063）作者简介：霍 燕（1975），女，副主任医师，主要从事中西医结合治疗心血管疾病研究临床研究 2023 年 8 月第 43 卷第 8 期 Jilin Journal of Chinese Medicine Aug.2023 Vol.43 No.8 919Xuefu Zhuyu decoction.Both groups were treated for 3 months.The efficacy after 3 months of treatment,the incidence of angina pectoris,the scores of the Seattle Angina
9、Questionnaire(SAQ),the traditional Chinese medicine syndromes,the levels of cardiac function and blood lipid were compared between the two groups before and after treatment.Results After 3 months of treatment,the total effective rate of the observation group was 90.00%,higher than 75.00%in the contr
10、ol group(P0.05).Compared with before treatment,after 3 months of treatment,the duration of angina pectoris was shortened in both groups,and the duration in the observation group was shorter than that in the control group(P0.05);the frequency of angina pectoris per week decreased in both groups,and t
11、he number of angina pectoris in the observation group was less than that in the control group(P0.05);the scores of SAQ,left ventricular ejection fraction(LVEF)and stroke volume(SV)increased in the two groups,and the scores in the observation group were higher than those in the control group(P0.05);t
12、he left ventricular end systolic diameter(LVESD),scores of chest tightness,chest pain,palpitations,shortness of breath,dark complexion,tiredness and fatigue,left ventricular end diastolic diameter(LVEDD),and the serum levels of B-type natriuretic peptide(BNP),low density lipoprotein cholesterol(LDL-
13、C),triglycerides(TG),total cholesterol(TC)decreased in the two groups,and those in the observation group were lower than those in the control group(P0.05).Conclusion In patients with angina pectoris after PCI,Xuefu Zhuyu decoction significantly improves their traditional Chinese medicine syndromes,l
14、owers their levels of blood lipid,significantly relieves their angina symptoms and cardiac function,and improves their quality of life and curative effect.Keywords:angina pectoris;percutaneous coronary intervention;Xuefu Zhuyu decoction;trimetazidine hydrochloride tablets;traditional Chinese medicin
15、e syndromes;cardiac function;blood lipid 经皮冠状动脉介入治疗（PCI）为冠心病的主要治疗方式之一，其可恢复患者心肌血流灌注，降低心血管疾病病死率，但其存在支架内血栓、术后再狭窄等诸多不足，易导致患者心肌供血减少，引发心绞痛，进而导致患者预后较差，因此术后用药尤为关键1-2。西医对于 PCI 术后心绞痛患者常给予加服盐酸曲美他嗪片进行治疗，该药可发挥营养心肌、改善心肌能量代谢的良好作用，但仅靠其单一治疗疗效有限3。中医将冠心病心绞痛归于“胸痹”范畴，认为外感邪气，内伤七情，致心脉失养、气血运行受阻导致血脉不通，不通则痛为其主要发病病机，故中医治疗应以活血
16、祛瘀、行气止痛为主4。血府逐瘀汤主要由川芎、桃仁、红花、柴胡、枳壳、赤芍等中药组成，具有活血行气、散瘀止痛的良好功效，可治疗胸痹5。但目前临床关于 PCI 术后心绞痛患者血府逐瘀汤治疗前后心功能和血脂水平变化仍需探究，故设立本研究报道如下。1 资料与方法1.1 一般资料 经山西省长治市中医研究所附属医院医学研究伦理委员会审核并批准后，采用随机数字表法将 120 例 2019 年 6 月 2022 年 6 月山西省长治市中医研究所附属医院中医心内科收治的 PCI 术后心绞痛患者分为对照组与观察组，各60例。对照组男32例，女 28 例；年龄 52 77 岁，平均（64.885.06）岁；体质量指数（BMI）19 27 kg/m2，平均（23.550.47）kg/m2；合并症类型：高血压21例，高脂血18例，2 型糖尿病 11 例；高血压+高脂血 3 例，高脂血+2型糖尿病 3 例，高血压+2 型糖尿病 2 例，高血压+高脂血+2 型糖尿病 2 例。观察组男 34 例，女 26 例；年龄 54 78 岁，平均（64.925.09）岁；BMI 19 28 kg/m2，平均（23.670.52